Effects of Sertraline on Brain Connectivity in Adolescents With OCD

To examine FSTC using advanced multi-modal imaging techniques, including resting-state
functional magnetic resonance imaging (R-fMRI) and high angular resolution diffusion imaging
(HARDI), in 25 medication-free adolescents youths with OCD (ages 8-17) in comparison with 25
matched healthy controls.

Hypotheses: (A) Based on the pilot data, adolescents youths with OCD will show lower
functional connectivity in FSTC at baseline when compared with controls, and , lower
functional connectivity in FSTC will correlate with greater severity on CY-BOCS. (B)
Adolescents Youths with OCD will also show abnormalities in structural connectivity in FSTC
at baseline when compared with controls, and structural and functional connectivity will be
related. (C) The investigators will explore relations between OCD dimensions and functional
connectivity measures, and predict that the repeating/ordering dimension will correlate with
orbitofrontal cortex (OFC) connections, hoarding will correlate with rostral anterior
cingulate cortex (ACC) connections, and forbidden thoughts will correlate with caudal ACC
connections.

To investigate how sertraline impacts functional connectivity in FSTC in adolescents with
OCD.

Hypothesis: After 12 weeks of sertraline treatment, functional connectivity measures within
FSTC for the OCD group will (on average) increase compared to baseline and will no longer be
significantly different when compared with controls. Non-responders may show a different
pattern (i.e. failure to show these changes).

Inclusion Criteria (OCD):

- OCD as the primary Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
(DSM-IV) diagnosis based on the Anxiety Disorders Interview Schedule (ADIS) for
DSM-IV, Child Version

- Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score of greater than 15

Exclusion Criteria (OCD):

- lifetime diagnosis of bipolar disorder, schizophrenia, or substance abuse/dependence
on ADIS

- Intelligence Quotient (IQ) < 80 on Wechsler Abbreviated Scales of Intelligence (WASI)

- positive urine drug screen

- MRI-incompatible features (e.g., metal implants, claustrophobia)

- current or recent trial of psychotropic medication (within the past 4 8 weeks or past
6 12 weeks for fluoxetine)

- non-response in > 2 selective serotonin reuptake inhibitor (SSRI) trials of adequate
dose/duration

- positive pregnancy test

- history of seizure disorder or serious head injury

Inclusion Criteria (Controls):

- Healthy 8-17 year olds

Exclusion criteria (controls):

- No psychiatric diagnoses

- No immediate family history of OCD